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Diphtheria 

How  TO  Recognize  the  Disease 
How  to  Keep  from  Catching  It 


How  TO  Treat  Those  WiHp  Do  Catch  It 


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t  \     t-LJ 

*—  KEEP  WELL  SERIES  No.  4 


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TREASURY  DEPARTMENT 
UNITED  STATES  PUBLIC  HEALTH  SERVICE 

1919 


OOVERNMENT  PRINTINQ  OFFICE 


Digitized  by  the  Internet  Archive 

in  2007  with  funding  from 

IVIicrosoft  Corporation 


http://www.archive.org/details/diphtheriahowtorOOunitiala 


Diphtheria 


TQTFTER  babyhood  has  passed,  beware  of 
•^  ^  diphtheria.  Of  all  the  deaths  of  chil- 
dren 3  and  4  years  of  age,  more  than  one- 
seventh  are  caused  by  diphtheria. 

Diphtheria  is  preventable  and,  when 
properly  treated  with  antitoxin,  is  curable. 
Most  of  the  children  who  die  from  diph- 
theria really  lose  their  lives  because  of  the 
ignorance  and  carelessness  of  their  parents. 

Diphtheria  is  a  disease  most  often  occur- 
ring in  children  and  resembling  a  sore 
throat  or  tonsillitis.  It  is  caused  by  a  small 
germ  called  the  diphtheria  bacillus.  The 
disease  may  resemble: 

A  very  mild  sore  throat,  the  tonsils  and 
back  of  the  mouth  being  redder  than  usual, 
and  the  person  not  feeling  ill. 

It  may  look  like  a  more  severe  sore  throat 
or  tonsillitis  with  a  white  or  grayish  patch, 
called  a  membrane,  on  the  tonsils.     There 

112094°— 19  3 


may  be  only  one  or  a  few  small  distinct 
patches,  and  the  throat  may  feel  somewhat 
sore.  The  glands  in  the  neck,  below  the 
tonsils,  may  be  slightly  enlarged  and  may 
feel  about  the  size  of  small  peas.  The 
patient  may  feel  rather  ill. 

Or  the  disease  may  be  like  a  very  severe 
sore  throat,  with  small  or  large  gray  or 
white  patches.  Not  only  the  tonsils  but 
also  the  uvula,  the  small  rounded  end  of 
the  palate  which  hangs  down  between  the 
tonsils,  may  have  on  it  white  or  gray 
patches.  (If  there  is  a  membrane  on  the 
uvula,  the  disease  is  almost  certainly  diph- 
theria.) With  such  a  throat  the  person 
feels  very  sick.  Not  only  does  the  throat 
hurt,  but  there  are  usually  aches  in  the 
back  of  the  neck  and  in  the  muscles  gen- 
erally. The  glands  in  the  neck  may  be 
quite  large  and  feel  painful  when  touched. 
The  soreness  in  the  throat  may  extend 
down  the  windpipe,  and  membranes  may 
form  there.  The  patient  is  feverish  and 
often  is  delirious.  The  fever,  however,  is 
not  necessarily  high. 


In  some  cases  the  membranes  may  form 
in  the  larynx  (Adam's  apple).  When  this 
is  the  case  the  patient's  voice  sounds  hoarse 
and  croupy,  and  the  child  may  breathe 
with  difficulty.  In  small  children  it  is  not 
uncommon,  if  such  cases  remain  untreated, 
for  this  membrane  to  choke  the  patient. 
Therefore,  in  all  cases  of  croup,  send  for  a 
doctor  immediately. 

THROAT  CULTURES. 

In  order  to  prevent  the  spread  of  diph- 
theria to  others  it  is  important  always  to 
recognize  the  presence  of  the  disease,  even 
in  mild  cases.  In  order  to  do  this  the  doc- 
tor makes  a  culture  from  the  throat  and 
nose  of  the  suspected  individual.  He  takes 
a  piece  of  sterile  cotton  wrapped  around 
the  end  of  a  thin  stick  oi^  wire  and  touches 
this  to  the  throat  and  tonsils,  especially 
where  there  are  patches  or  membranes. 
Then  he  sends  this  swab  to  a  laboratory, 
where  cultures  are  planted  from  it.  The 
next  day  these  cultures  are  examined  with 


a  microscope  to  see  if  diphtheria  bacilli, 
the  germs  which  cause  diphtheria,  are 
present. 

Since  the  diphtheria  germs  or  bacilli 
grow  on  the  lining  of  the  throat  and  air 
passages,  they  are  easily  thrown  out  from 
the  mouth  and  nose  of  the  patient  with 
particles  of  mucus  or  spit  when  the  patient 
coughs,  spits,  or  sneezes.  But  even  when 
the  patient  talks,  especially  when  he  talks 
loudly,  tiny  droplets  of  mucus  or  spit  are 
given  off.  These  droplets  may  have  diph- 
theria bacilli  on  them.  The  same  is  true 
of  particles  of  food,  no  matter  how  small, 
falling  from  the  patient's  lips.  Eating 
utensils  such  as  cups,  glasses,  forks,  and 
spoons  that  have  touched  the  lips  of  the 
patient  may  likewise  have  saliva  on  them. 
When  the  patient  has  diphtheria  all  these 
droplets  of  saliva  and  of  mucus  may,  and 
usually  do,  contain  many  diphtheria  bacilli. 
Curiously,  some  persons  may  have  diph- 
theria bacilli  in  the  nose  and  throat  and 
yet  remain   entirely  well.     Such  persons 


are  called  "  healthy  carriers."  They  are 
especially  dangerous,  because  there  is  no 
outward  sign  which  will  tell  them  or  others 
that  they  are  carrying  deadly  disease  germs 
around. 

All  who  attend  the  patient  must  be  very 
careful  not  to  get  any  of  the  dangerous  dis- 
charges from  the  patient's  mouth  or  nose 
on  the  hands.  In  fact,  it  is  important  for 
the  attendant  always  to  wash  her  hands 
promptly  after  waiting  on  the  patient.  Be- 
sides this,  care  should  be  taken  that  the 
germs  are  not  carried  to  others  by  the  use 
of  eating  utensils,  such  as  cups,  glasses, 
spoons,  forks,  or  plates.  All  of  these 
should  be  sterilized  with  boiling  water 
after  each  meal. 

ANTITOXIN  TREATMENT. 

Depending  on  the  way  it  is  treated,  diph- 
theria is  one  of  the  least  dangerous  or  one 
of  the  most  dangerous  diseases.  It  is  one 
of  the  least  dangerous  when  promptly 
treated  with  antitoxin;  it  is  one  of  the  most 


dangerous  when  the  antitoxin  treatment  is 
not  given,  or  is  delayed  or  insufficient  In 
the  days  before  we  had  antitoxin  one  out 
of  every  three  children  who  had  diphtheria 
died.  Now,  if  antitoxin  is  used  on  the  first 
or  second  day  of  the  disease  ninety-eight 
out  of  every  hundred  children  recover. 
The  sooner  diphtheria  is  attended  to  the 
more  certain  is  a  cure. 

In  severe  cases  suspected  to  be  diph- 
theria the  doctor  always  gives  diphtheria 
antitoxin  at  once.  This  is  a  wise  thing  to 
do,  because  the  disease  goes  on  rapidly 
and  a  delay  of  12  or  24  hours  may  be  fatal. 
Besides,  no  harm  is  dojie,  even  if  the  dis- 
ease proves  not  to  be  diphtheria.  The 
antitoxin,  although  making  some  people 
uncomfortable  for  a  day  or  two,  never  does 
any  real  harm.  Whenever  antitoxin  is 
given  to  a  person  ill  with  diphtheria  it 
should  be  given  in  one  dose,  large  enough 
and  early  enough. 


TEMPORARY  PROTECTION  WITH  ANTITOXIN. 

Diphtheria  is  very  contagious,  and  many 
people,  especially  children,  can  catch  it. 
For  this  reason,  whenever  a  case  of  diph- 
theria is  discovered,  the  doctor  injects  the 
antitoxin  not  only  into  the  patient,  but 
also,  as  a  protective  against  the  disease, 
into  those  who  have  come  into  contact 
with  the  patient.  This  is  spoken  of  as 
"immunizing"  these  individuals.  The  im- 
munizing dose  is  not  so  large  as  the  cura- 
tive dose  given  to  the  patient,  but  it  is  usu- 
ally sufficient  to  protect  those  exposed  to 
diphtheria  for  a  month  from  the  time  of 
injection.  At  the  end  of  that  time  the  pro- 
tection disappears. 

THE  SCHICK  TEST. 

A  few  years  ago  a  very  simple  test  was 
discovered  to  tell  whether  a  person  could 
or  could  not  catch  diphtheria.  This  is 
known  as  the  Schick  test.  It  consists  in 
injecting  a  few  drops  of  a  prepared  diph- 
theria toxin  into  the  skin  and  then  watch- 


ing  whether  a  characteristic  red  spot  ap- 
pears where  the  injection  was  made.  If 
such  a  spot  does  not  appear  within  two  or 
three  days  it  shows  that  the  person  can  not 
catch  diphtheria. 

LASTING  PROTECTION  BY  DIPHTHERIA 
VACCINATION. 

For  those  in  whom  the  characteristic 
redness  appears,  and  who  are  therefore 
known  to  be  liable  to  catch  diphtheria, 
doctors  now  advise  a  course  of  protective 
injections  similar  to  those  which  have 
proven  so  successful  against  typhoid  fever. 
This  protective  treatment  consists  of  three 
small  injections,  a  week  apart.  There  is 
no  sore,  as  there  is  in  smallpox  vaccina- 
tion, and  the  injections  are  harmless.  The 
protection  lasts  for  years,  and  perhaps  even 
for  life. 

Why  not  have  the  doctor  make  a  Schick 
test  on  your  child,  and  if  this  shows  the 
lack  of  protection  against  diphtheria  have 
him  give  the  three  protective  injections? 

10 


PERSONAL  AND  BEDSIDE  HYGIENE. 

1.  (a)  All  discharges  from  the  nose  and 
mouth  should  be  gathered  in  soft,  clean 
cloths  or  rags  or  papers  and  destroyed  by 
burning,  (b)  The  patient  should  cover  the 
mouth  and  nose  when  coughing  or  sneez- 
ing, for  a  cough  or  sneeze  will  throw  drop- 
lets of  mucus  to  a  distance  of  10  or  12  feet. 

2.  The  attendant  should  wear  a  washable 
gown  that  completely  covers  her  clothing. 
It  should  be  put  on  when  entering  the  room 
of  the  patient  and  taken  off  immediately  on 
leaving  it. 

3.  A  basin  of  water,  together  with  a  cake 
of  castile  soap  (or  where  possible  an  anti- 
septic solution),  should  be  placed  in  a  con- 
venient place,  so  that  the  doctor  and  nurse 
attending  the  patient  may  wash  their  hands 
whenever  leaving  the  room,  and  even  be- 
fore touching  the  door  handle. 

4.  All  eating  utensils  that  the  patient  uses 
should  be  washed  in  boiling  hot  water  sep- 
arately from  other  dishes  and  used  exclu- 
sively by  the  patient. 

It 


5.  All  bedclothes  and  bedding  should  be 
boiled  in  soap  and  water,  or  they  should  be 
exposed  to  the  sunshine.  Direct  sunshine 
kills  disease  germs. 

6.  The  person  attending  the  patient 
should  wear  a  double  layer  of  gauze  or 
other  soft  thin  cloth  across  the  mouth  and 
nose  as  a  face  mask  whenever  near  the 
patient  so  as  to  prevent  the  droplets  con- 
taining the  germs  coming  from  the  pa- 
tient's mouth  from  entering  and  lodging 
on  the  lining  of  the  mouth  or  throat  of  the 
attendant.  Always  remember  that  even 
though  you  may  not  get  the  disease  if  the 
germs  lodge  in  your  throat  they  may  grow 
there  and  you  may  carry  the  disease  to 
another  person  who  may  catch  it. 

7.  There  should  be  but  one  attendant 
wherever  possible. 

8.  No  visitors  should  be  permitted  in  the 
sick  room — not  even  during  convalescence. 

9.  The  one  who  attends  the  sick  should 
not  prepare  or  handle  the  food  of  others. 

18 


Sometimes  it  is  impossible  to  take  this  pre- 
caution, as  very  often  it  is  the  mother  who 
must  take  care  of  the  patient,  cook,  and  do 
all  the  housework.  In  such  cases  the  one 
attending  the  sick  must  never  neglect  when- 
ever near  the  patient — 

(1)  To  wear  a  face  mask. 

(2)  To  wear  a  washable  gown  (which 

is  to  be  taken  off  on  leaving  the 
room). 

(3)  To  wash  her  hands  when  leaving 

the  sick  room. 

Every  attendant  on  the  sick  should  know 
how  disease  germs  are  carried  from  the 
sick  to  the  well.  This  knowledge  should 
make  her  more  careful,  and  thus  help  to 
prevent  the  spread  of  the  disease. 


,,'/C  SOUTHERCJ  REGIONAl  LIBRARY 


001293  348 


For  other  instructive  Health  Leaflets 

write  to  the — 

UNITED  STATES 

PUBLIC  HEALTH  SERVICE 

WASHINGTON,  D.  C. 


ts 


